HIV prevention strategy key to curbing epidemic and cutting long-term treatment costs

The analysis of HAART coverage in British Columbia, published recently in AIDS, the official journal of the International AIDS Society (IAS), is the first comprehensive economic evaluation of the net benefit of HAART in the province. HAART lowers viral load, stopping HIV from progressing to AIDS in individuals and helping to prevent HIV transmission. The study's key finding shows that while expanding HAART use is cost-effective for individual patients, the benefits become exponentially greater when HAART's ability to prevent HIV transmission is considered.

The economic analysis demonstrated that increasing HAART treatment coverage from the current estimated 50 per cent to 75 per cent of all clinically eligible British Columbians (HIV-infected individuals with CD4 cell counts below 350 cells/ ul) would deliver a net benefit of US$900 million over 30 years.

"The study findings make the point that expansion of HAART is not just a medical or ethical imperative, it is a very smart financial investment in terms of its potential to improve public health," said Dr. Julio Montaner, director of the BC-CfE, president of the IAS, and one of the authors of the study.

"HIV continues to be a global health concern and the lifetime costs of treating individuals with HIV are substantial. Therefore, HAART's potential to prevent new HIV infections is an important element of the overall strategy to minimize the economic burden on the health care system of treating HIV," added Montaner, who is also a professor and Chair in AIDS Research at the University of British Columbia.

The study, Expanding access to HAART: a cost-effective approach for testing and preventing HIV, provides the first analysis that incorporates the impact of HAART on prevention based on real data. The study was undertaken from a taxpayer perspective. Only direct medical costs such as antiretroviral and non-antiretroviral medications, hospitalizations, physician visits and laboratory tests were considered. The study was based on high-quality population-based data for B.C. Researchers expect that the findings can be accurately applied to other areas with similar healthcare systems.

Within B.C., the sub-populations most affected by HIV are hard-to-reach, marginalized groups such as sex trade workers, injection drug users and men who have sex with men. Prevention of new infections among these HIV-vulnerable groups must be a priority in order to meaningfully curb the growth of the epidemic. In this context, the study findings lend further credence to the BC-CfE-pioneered Seek and Treat strategy.

The B.C. government recently invested in a $48-million, four-year pilot project in Prince George and Vancouver's Downtown Eastside to extend HAART treatment to all people in medical need living with HIV. The Seek and Treat program will improve access to HIV/AIDS treatment and care among hard-to-reach populations. The program is currently being evaluated as part of the BC-CfE's innovative research program, Seek and Treat for the Optimal Prevention of HIV/AIDS (STOP HIV/AIDS).

The Seek and Treat strategy has increasingly gained acceptance internationally, with pilot projects being implemented in some U.S. cities.

Seek and Treat is central to the BC-CfE's work in turning the tide against the epidemic. Seek and Treat aims to engage people into appropriate care, including HIV testing and antiretroviral treatment, as soon as medically indicated. The BC-CfE's research has conclusively shown that appropriate use of antiretroviral treatment halts the progression of HIV infection to AIDS and death and dramatically reduces the chances of HIV transmission.

With the support of the B.C. government, the BC-CfE is currently evaluating further strategies and undertaking a wide variety of scientific studies and economic analyses to harness the full potential of antiretroviral treatment in the province. This work is being closely followed by international agencies, including UNAIDS and WHO, as it provides unique insights into the most efficient ways to deal with the global HIV pandemic. In the absence of an HIV vaccine or cure, Seek and Treat, as proposed by the BC-CfE, provides an innovative option to help HIV-infected individuals live full and fulfilling lives, prevent HIV transmission and curtail the human suffering and economic costs of HIV infection.